May 7, 2014 — The American College of Radiology said it is deeply disappointed at the failure of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) to vote in support of national Medicare coverage of low-dose computed tomography (LDCT) screening for patients at high risk for lung cancer.
Based on available evidence, including National Lung Screening Trial (NLST) results, new guidelines and standards, and developing screening infrastructure — some of which MEDCAC members may not have been allowed to consider — the college continues to recommend that the Centers for Medicare & Medicaid Services (CMS) provide full Medicare coverage of these lifesaving exams. Lack of national Medicare coverage for CT lung cancer screening places many Medicare beneficiaries at a potentially lethal disadvantage to those covered by private insurance regarding lung cancer survival.
In December 2013, the U.S. Preventive Services Task Force (USPSTF) recommended screening of asymptomatic adults aged 55 to 80 years who have a 30 pack/year smoking history and currently smoke or have quit within the past 15 years. The Affordable Care Act (ACA) requires that private insurers cover all medical exams or procedures that receive a grade of “B” or higher from the USPSTF without a co-pay. Somewhat inexplicably, the ACA does not specify that Medicare provide the same full national coverage for the Medicare population.
“Without national Medicare coverage for CT lung cancer screening, seniors face a two-tier coverage system in which those with private insurance will be covered for these exams and many of their lives saved, while Medicare beneficiaries are left with lesser access to these exams and placed at increased risk of dying from lung cancer. CMS needs to move for full national coverage as the USPSTF recommendations would indicate,” said Ella Kazerooni, M.D., chair of the American College of Radiology Lung Cancer Screening Committee.
NLST results and those of other smaller international randomized controlled trials show that CT lung cancer screening significantly reduces lung cancer deaths. The ACR, the Lung Cancer Alliance, the Society of Thoracic Surgeons and 38 other medical organizations urge CMS to provide full national coverage for high-risk patients as defined in the USPSTF and provide coverage with evidence for other high-risk patients not included in USPSTF recommendations using data collected through existing registries.
“The absence of Medicare coverage for CT lung cancer screening, as recommended by the USPSTF, penalizes many seniors and may result in lives lost. We now have a chance to strike back against the nation’s leading cancer killer, but only if people have access to these lifesaving exams. We strongly urge CMS to act on the evidence and the USPSTF recommendations to provide full national coverage of CT lung cancer screening for high-risk patients,” said Bibb Allen, M.D., FACR, chair of the ACR Board of Chancellors.
For more information: www.acr.org